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Monitoring Systema Certification Site Address: -SOS A AJ5 Date of Testing/Servicing: (S Z6 of F In-Tank Gauging/SIR Equipment: -0 Check this box if tank gauging is used only for inventory control. ❑ Check this box if no tank gauging or SIR equipment is installed. This section must be completed if in-tank gauging equipment is used to perform leak detection monitoring. Complete the following checklist: ❑ yes ❑ No* Has all input wiring been inspected for proper entry and termination,including testing for ground faults? ❑ yes ❑ No* Were all tank gauging probes visually inspected for damage and residue buildup? ❑ yes ® No* Was accuracy of system product level readings tested? ❑ Yes ❑ No* Was accuracy of system water level readings tested? ❑ yes ❑ No* Were all probes reinstalled properly? ❑ yes ❑ No* Were all items on the equipment manufacturer's maintenance checklist completed? *In the Section H,below,describe how and when these deficiencies were or will be corrected. G. Line Leak Detectors (LLD): ❑ Check this box if LLDs are not installed. Complete the following checklist: Yes ❑ No* For equipment start-up or annual equipment certification, was a leak simulated to verify LLD performaarice? ❑ N/A (Check all that apply) Simulated leak rate: 3 g.p.h.'; ❑0.1 g.p.h.2; ❑02 g.p.h.2 Notes: 1. Required for equipment start-up certification and annual certification.- 2. Unless mandated by local agency,certification required only for electronic LLD start-up. ❑ Yes _p No* Were all LLDs confirmed operational and accurate within regulatory requirements. jP Yes ❑ No* Was the testing apparatus properly calibrated?. C] yes No*. For mechanical LLDs,does the LLD restrict product flow if it detects a leak? ❑ N/A ❑ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off.if the LLD detects a leak? 0 N/A ❑ Yes ❑ No* For electronic LLDs,does the turbine automatically shut off if any portion of the monitoring system is disabled l N/A or disconnected? ❑ Yes ❑ No* For electronic LLDs, does the turbine-automatically shut off if any portion of the monitoring system )29 NIA malfunctions or fails a test? ❑ Yes ❑ No* For electronic LLDs,have all accessible wiring connections been visually inspected? ,E1 N/A Yes Cl No* Were all items on the equipment manufacturer's maintenance checklist completed? 1 *In the Section H,below,describe how and when these deficiencies were or will be corrected. H. Comments: C?Z-